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1. Introduction
*Universit de
Montral
Department of
Psychology
CERNEC, CP 6128,
Montral, Qubec
H3C 3J7
Canada
e-mail:
laurence.dumont.1@
umontreal.ca
1.1 Hypnosis
While the word Hypnosis is a term derived from
the Greek word hypnos which means sleep,
it has been shown that these two states have
little in common when it comes to brain activity (Halsband, Mueller, Hinterberger, & Strickner,
2009). Hypnosis is seen as either an altered state
of consciousness or a cooperative interaction in
which one person, the subject, becomes highly
focused and receptive to verbal suggestions given
by another person, the hypnotist. The subject is
guided by the hypnotist to respond to suggestions
for specific changes in subjective experience, sensation, perception, thought, emotion, or behavior. But hypnosis does not necessarily have to involve another person. Hypnotic suggestions can
also be self-administered: a hypnotic state that is
self-created is called autohypnosis (or self-hypnosis) (Rainville & Price, 2003). However there are,
to our knowledge, no fMRI studies investigating
self-hypnosis to date. Hence this review will focus on means of hypnotic induction that include
a hypnotist or a recording.
In order to get a clear picture of the workings
of hypnosis in the brain, two components must be
differentiated. The first aspect is the basic putative
change of state following a hypnotic induction procedure without further targeted suggestions (i.e.,
neutral hypnosis). The second aspect regards the
influence of specific suggestions provided during
a hypnosis session. Two main types of hypnotic
induction are recognized in the literaturerelaxation and active/alert inductionsthough most
neuroscientific studies have concentrated on the
former. The changes in subjective experience that
follow relaxation-based hypnotic inductions typically include mental relaxation (i.e, becoming at
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Over the last few decades, an increasing number of functional neuroimaging studies have been
performed with respect to hypnosis and meditation. The objective of this article is to review a number of these studies to compare the neural substrates related to different components of hypnosis
and meditation. We examine neuroimaging studies conducted to explore the impact of hypnosis on
the brain regions and systems involved in color perception, hand paralysis, pain, and the defaultmode network (DMN). We also review neuroimaging investigations carried out to examine the
neural correlates of various meditation techniques, as well as the effects of meditation on the brain
mechanisms related to emotion, pain, and the DMN. Given the discrepancy existing between the
findings from neuroimaging studies of hypnosis and meditation carried out in regard to pain and
the DMN, we conclude that it is premature to claim that hypnosis and meditation are mediated by
similar brain systems and neural mechanisms.
ease, letting go of tensions) and mental absorption (i.e., a shift from an effortful and ever changing focus of attention to the full concentration on
a particular object, whether it be internal or external). Such alterations lead to a decrease in the
sense of time (Kroger & Yapco, 2007). Hypnosis
can also be characterized by a reduced sense of
self-monitoring and self-agency. This reduction is
manifested by feelings of automaticity associated
with thoughts or actions (Rainville & Price, 2003;
Grant & Rainville, 2005; Price, 1996).
1.2 Meditation
The term meditation comes from the Latin meditatio which originally meant to think, contemplate . Meditation usually refers to a very
wide range of mental techniques associated with
Hindu, Buddhist, Jewish, Christian, and Islamic
traditions (Halsband et al., 2009). A popular
distinction between two components present in
meditation has been made by Lutz et al. (2008).
These components are open monitoring (OM)
and focused attention (FA). OM techniques involve allowing any sensations, thoughts, or feelings to arise and pass away from moment-to-moment, while maintaining awareness as an attentive
and non-attached observer without judgment
or analysis. These techniques cultivate metaawareness and observation of experience. FA
techniques involve focusing attention on specific
objects (e.g., mantra, religious pictures, scriptural
passage), body sensations (e.g., breath), or other
types of mental events (e.g., imagined images). A
third subdivision in types of meditation, automatic transcendental meditation, has also been suggested by Travis & Shear (2010). The purpose of
these techniques involves going beyond the usual
realm of sensations and experiences to transcend
their own activity.
These broad classifications intend to foster a
sense of coherence and help draw more general
conclusions about the effects and workings of
meditation. This would be achieved by separating
clearly different entities present in the realm of
meditation. The authors of both the original classification (Lutz et al. 2008) and its revision (Travis
& Shear, 2010) mentioned the fact that the different categories are neither exclusive from each
other nor constant during a meditation session,
between types of session, or even across practitioners. Such intricacies have yet to be explored by
research and should be brought forward in future
efforts to better characterize the phenomenology
of meditation.
1.3 Comparison
Some nuances must be mentioned in order to
understand the subtleties that differentiate hypnosis and meditation and to avoid a black and
white portrait of similarities and discrepancies.
These nuances must be kept in mind throughout
the present review in order to maintain a critical eye on the reviewed literature, as the studies
themselves do not always take these factors into
consideration.
Both hypnosis and meditation experiencers feel qualitative changes in mental functioning such that their consciousness is distinct from
the way it usually operates (Tart, 1972). Other
elements common to both neutral hypnosis and
meditation include relaxation, attentional focus, concentration, and absorption (Holroyd,
2003; Otani, 2003). In addition, both hypnosis
and meditation are associated with alterations in
self-awareness, time sense, and perception (Ott,
2007). An interesting parallel to draw between
both states is the importance of the capacity to
immerse ones phenomenological experience in a
particular object. Regarding hypnosis, absorption
capacity has been strongly correlated to hypnotisability numerous times and is thought by some
researchers to be a core component of hypnosis
(Cardena, 1991; Nadon et al. 1991; Green & Lynn
2010). Absorption also seems to be linked to
meditation (Davidson et al. 1976).
Both hypnosis and meditation can be either
self- or externally- induced. In the case of hypnosis, the traditional way is to be brought into hypnosis by a hypnotist but it is possible for someone
to learn to hypnotize themselves or to follow a
recording instead of an actual human being. As
for meditation, while typically this activity is selfinitiated and self-monitored, it also often involves
a teacher that will guide the practitioners mental
activity before or during meditation. Halsband et
al. (2009) argued that social interactions were a
differentiating point between both states but the
preceding facts (self-hypnosis, guided meditation, etc.) cast doubt on this clear cut distinction.
Traditionally, hypnosis has been seen in the
terms of enhanced response to suggestions, yet it is
also possible to undergo neutral hypnosis without specific suggestions. Both componentsneutral hypnosis and targeted suggestionsoften fail
to be distinguished within the studies discussed
further, but it will be mentioned throughout the
review if the original authors addressed such nuances. The specific role of suggestion in meditation is far from being as clearly determined in the
scientific literature (for in-depth discussions on
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2. Functional neuroimaging
studies of hypnosis
2.1. Visual perception and conversion paralysis
both middle occipital gyri and various other regions at the voxel level, several of which were in
the DMN*) were present following suggestion in
hypnosis compared to suggestion in normal waking consciousness. This evidence highlights the
difficulty of dissociating the added contribution
of hypnotic induction to altered color perception
but eloquently replicates the power of suggestion
in modulating perception.
Other researchers have attempted to measure
the neural correlates of hypnosis-induced paralysis. In one study, Pyka and co-workers (Pyka,
Burgmer, Lenzen, Pioch, Dannlowski, Pfleiderer,
Ewert et al., 2011) scanned highly suggestible subjects with fMRI to investigate brain activity mediating hypnotic left-hand paralysis. Hypnotic
induction began with suggestions such as the
left hand feels weak, heavy. These suggestions
were followed by direct suggestions such as the
left hand is paralyzed, you cannot move the hand
anymore. Subjects under hypnotic suggestion
reported feeling that they were not able to move
their left hands. Interestingly, the left-hand paralysis induced by hypnosis was not associated with
activation of brain areas involved in the inhibition of movement. Indeed, functional connectivity analyses revealed enhanced connectivity of the
precuneus with the right dorsolateral prefrontal
cortex (DLPFC), a cortical area known to be involved in cognitive control (Frith, 2000). Pyka
et al. (2011) argued that the increased coupling
of the precuneus supports the view that hypnotic
paralysis may be related to an altered representation of the self which affects motor abilities. These
researchers further proposed that the increased
coupling of the right DLPFC with the precuneus
may support the idea that hypnotic paralysis of
the left hand was maintained by cognitive control processes implemented by the contralateral
DLPFC. Similar results were obtained by Cojan
and collaborators (Cojan et al. 2011) using a go/
no-go task. In half of the blocks, a hypnotic induction was followed by suggestion of paralysis
of the left hand. A control group was also asked to
feign hand paralysis to account for willful withholding of the movement (though when reading the instructions that were given, it could be
argued that a suggestion had been made). Even
when under induced paralysis, preparatory motor activity was still found but activity from M1
was decoupled from the activity in the premotor
areas and functional connectivity was increased
in the precuneus. These findings support the notion that modifications in self-monitoring are at
play when eliciting suggested rather than willed
behaviour.
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2.2. Pain
Pain is a multi-dimensional experience that includes sensory-discriminative, cognitive, emotional, and behavioural components (Price, 1996;
Peyron et al., 2000; Knudsen et al., 2011). These
various components are mediated by neural circuits commonly referred to as the pain matrix
(Peyron, Laurent, & Garcia-Larrea, 2000). This
functional brain network involves the brainstem, thalamus, insula, anterior cingulate cortex
(ACC), primary (S1) and secondary (S2) somatosensory cortices. Neuroimaging findings support
the contention that two distinct neural circuits are
implicated in pain perception. On this view, the
somatosensory thalamus (lateral thalamic nuclei)
and its projections to the primary and secondary
somatosensory cortices are involved in the sensory component of pain, whereas the emotional
component implicate the medial thalamic nuclei
and its projections to the ACC and prefrontal cortices (Hofbauer, Rainville, Duncan, & Bushnell,
2001). As for the insula, this cerebral structure
acts as an intermediary between the sensory and
emotional components of pain (Augustine, 1996).
Rainville et al. (Rainville, Duncan, Price,
Carrier, & Bushnell, 1997) used PET and hypnosis
to investigate the cerebral structures involved in
the emotional aspect of pain. Hypnotic suggestions were given to healthy subjects to change
the unpleasantness of noxious stimuli (painfully hot water) without altering the perceived
intensity. The levels of activation within the ACC
were consistent with the perceived unpleasantness of these noxious stimuli, whereas primary
somatosensory cortex activation was unaffected.
Rainville and colleagues (Rainville, Hofbauer,
Paus, Duncan, Bushnell, & Price, 1999) utilized
PET also to explore the neural mechanisms underlying hypnotic states and responses to hypnotic suggestions. Regional cerebral blood flow was
measured during rest (Baseline), hypnotic relaxation alone (Hypnosis), and hypnotic relaxation
with suggestions (Hypnosis-with-Suggestion) for
altered pain unpleasantness. Subjects had their left
hand immersed in neutral or hot waterin the
Baseline and Hypnosis conditionsand in painfully hot water in the Hypnosis-with-Suggestion
condition. In this condition, suggestions for High
or Low pain unpleasantness were given to the
subjects. Results revealed that hypnosis was accompanied by both rCBF increases (in occipital
areas, inferior frontal gyri, right anterior cingulate sulcus, right anterior superior temporal gyrus, and left insula) and rCBF decreases (in the
right inferior parietal lobule, medial precuneus,
left posterior cingulate gyrus, left medial superior
frontal gyrus, and left posterior middle temporal
areas). Likewise, hypnosis-with-suggestions (for
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2.4. Summary
Findings from functional neuroimaging studies demonstrate that hypnotic suggestions can
modulate the neural activity supporting colour
perception and the experience of painful stimuli. There is also some evidence indicating that
suggestions of hypnotic analgesia can result in a
reduction of activity in certain areas of the pain
matrix. The situation is more complicated with
regard to the neural correlates of the putative
hypnotic state. Indeed, while some findings indicate that there is a reduction of activity in various
regions of the PFC following hypnotic induction
(McGeown et al., 2009), other findings indicate
that hypnosis (without suggestions) may be mediated by increased activity in distinct prefrontal
cortical areas (Rainville et al., 1999). Nonetheless
it seems that neutral hypnosis is associated with a
distinct anterior alteration of the DMN.
3. Functional neuroimaging
studies of meditation
3.1. Basic neural substrates
In recent years, many functional imaging studies
have explored the neural correlates of different
types of meditation, including OM, FA, transcendental, or even mixed meditative practices. In a pilot investigation, Newberg et al. (Newberg, Alavi,
Baime, Pourdehnad, Santanna, & dAquili, 2001)
scanned eight experienced Tibetan Buddhist
meditators with single photon emission computed tomography (SPECT) while they focused their
attention on a mental image. They were scanned
twice, once during meditation and once during
normal resting wakefulness. Experientially, the
meditators reported becoming one with the visualized image during the meditative state. The
baseline activation patterns revealed a difference
in the thalamic laterality index in which meditators displayed a greater rightward dominance of
thalamic rCBF compared to controls. Increased
rCBF was measured in the cingulate gyrus, inferior and orbital frontal cortex, DLPFC, midbrain,
and thalamus during meditation relative to baseline. In addition, decreased rCBF activity in the
left posterior superior parietal lobe was negatively
correlated with the activity increase noted in left
DLPFC. Newberg and colleagues suggested that
the increased frontal rCBF may reflect focused
concentration while thalamic increases may be
correlated with increased cortical activity during
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* It is important to specify
that an extensive and longterm commitement to
meditation is necessary to
attain a certain mastery of
the discipline. It is the main
reason why a separation can
be drawn between practitionners who all seem to have
plenty of experience in the
eye of the layperson.
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3.3. Pain
Similarly to hypnosis, meditation has been shown
to be highly effective is in its ability to reduce
the intensity and emotional perception of pain.
With respect to this issue, Grant and colleagues
(Grant, Courtemanche, & Rainville, 2011) used
fMRI to examine the brains of Zen meditators
during painful stimulation. To induce pain, thermal stimuli were applied to the inner surface of
the left calf. During pain induction, meditators
showed greater activation of primary pain processing regions (ACC, thalamus, insula), compared to controls. In addition, in meditators
relative to controls, decreased activity was found
in appraisal and emotion areas (e.g., lateral and
medial PFC, amygdala and posterior cingulate
cortex) during the administration of the painful
stimuli. Furthermore, reductions in functional
connectivity between executive and pain-related
cortices strongly predicted lower pain sensitivity
in meditators. Grant et al. (2011) hypothesized
that the disengagement of anterior brain systems
in meditators may reflect a functional decoupling
of the cognitive-evaluative and sensory-discriminative components of pain. Such a phenomenon
would allow Zen meditators to perceive painful
stimuli in a mindful manner, that is, more neutrally from an emotional perspective.
In one investigation conducted by Gard et
al. (Gard, Hlzel, Sack, Hempel, Lazar, Vaitl, &
Ott, 2011), mindfulness practitioners and controls were given unpleasant electric shocks in
the fMRI scanner during a mindful state and a
control condition. Mindfulness practitioners, but
not controls, were able to decrease pain unpleasantness by 22% during the mindful state. This
decrease was accompanied by reduced activation
in the lateral PFC and enhanced activation in
the right posterior insula during painful stimulation. These findings suggest that mindfulness
increases sensory processing and diminishes cognitive control, confirming the role of meditation
in the reduction of cognitive-evaluative aspects
of pain (Grant et al, 2011). In another investigation (Zeidan, Martucci, Kraft, Gordon, McHaffie,
& Coghill, 2011), arterial spin labelling fMRI was
used to investigate the neural mechanisms by
which mindfulness modulates pain in healthy
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individuals. The experiment was performed after 4 days of mindfulness meditation training.
Noxious (thermal) stimuli were administered to
subjects during a restful state and a mindful state.
Mindfulness significantly diminished pain unpleasantness (by 57%) and pain intensity ratings
(by 40%) relative to the rest condition. Neurally,
mindfulness meditation decreased pain-related
activation of the contralateral S1. Mindfulnessinduced decreases in pain intensity ratings were
correlated with enhanced activity in the ACC and
anterior insula
Heeger, 2011) recorded the brain activity of experienced meditators from the Tibetan-Buddhist
tradition, while they fixated without meditation
(fixation) or engaged in either non-dual awareness (NDA or transcendental) or FA meditation.
The anti-correlation between intrinsic (or DMN)
and extrinsic networks seemed to be stronger in
FA than in rest, and lower in NDA meditation
when compared to rest. On the other hand, correlation between areas within the DMN did not
change during NDA meditation and FA meditation, relative to fixation without meditation.
In another investigation, Brewer and colleagues
(Brewer, Worhunsky, Gray, Tang, Weber, & Kober,
2011) measured brain activity in experienced
meditators and matched meditation-nave controls as they performed three distinct meditations
[Concentration (FA), Loving-Kindness (practiced through directed well-wishing;) Choiceless
Awareness (OM or attention to whatever arises in
ones conscious field of awareness at any moment)]
(Gunaratana, 2002). Across all meditation types,
experienced meditators showed deactivation in
core regions of the DMN (medial prefrontal and
posterior cingulate cortices). Moreover, a greater
coupling in experienced meditators was found
between cortical areas of the DMN thought to be
involved in self-monitoring and cognitive control
(posterior cingulate, dorsal ACC, and DLPFC),
both at baseline (restful state) and during meditation. This account also reported a relative absence
of involvement of the extrinsic network, which is
coherent with the supposed absence of stimulusindependent thoughts achieved in meditation. In
addition, the consistency of connectivity patterns
within DMN areas across meditation and baseline periods indicates that meditation practice
may alter the resting-state experience such that it
is similar to a meditative state (Brewer et al., 2011).
The increased connectivity within the DMN, yet
lowered activity, seems to point towards a more
efficient recruitment of this network.
Aiming to confirm the notion that meditation alters the efficiency of DMN recruitment,
Jang and co-workers (Jang, Jung, Kang, Byun,
Kwon, Choi, & Kwon, 2011) employed fMRI to
investigate functional connectivity within the
DMN during a resting state (fixation on a foveal
crosshair). Healthy controls and brain-wave vibration meditation practitioners were recruited.
Brain-wave vibration meditation is believed to
help quiet the mind and release negative emotions
through focusing on bodily sensations while performing natural rhythmic movements. Thus, this
form of meditation likely reflects a combination
of both FA and OM practice. At rest, meditation
practitioners showed greater functional coupling
within the DMN in the medial prefrontal cortex
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3.6. Summary
Globally, the findings from functional neuroimaging investigations indicate that concentrative meditation techniques are accompanied by
enhanced activity in cortical areas known to be
involved in sustained attention. With respect to
the neural correlates of mindfulness, however,
brain imaging studies present conflicting results.
Effectively, whereas some investigations suggest
that mindfulness is mediated by an overall decrease in brain activity (e.g., Ives-Deliperi et al.,
2011), the results of other investigations indicate
instead that this form of meditation is correlated
with enhanced activity in various prefrontal, parietal, and temporal regions (e.g., Manna et al.,
2010). Findings from other studies suggest that
meditation can influence neural activity supporting the processing of emotional (Taylor et al.,
2011) and painful (Grant et al., 2011; Gard et al.,
2011; Zeidan et al., 2011) stimuli. Still, there are
consistent effects of meditation on processes involving the DMN and compelling evidence that
meditation leads to enduring changes in brain
structure.
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References
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Augustine, J. R. (1996). Circuitry and functional aspects of the insular lobe in primates including humans. Brain Research
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